perspective

• inside the box... a problem-solving approach

  • a pharmacy management tool and a problem solving tool
• virtue ethics

  • advocated by Aristotle and somewhat St. Thomas Aquinas
  • has had something of a re-birth in last fifty years or so
  • focuses on the inherent character of a person versus their specific acts
  • example (thought process):
  • running a stop sign that is hard to see
  • is it wrong? well, yes
  • does it make you a "bad" person? unethical? and all you prior good deeds count for nothing?
  • no
• normative ethics

  • a starting point
  • how do you as a pharmacist and pharmacy management answer ethical questions?
  • you will face ethical dilemmas
  • normative -- what you 'should do'
  • what would a reasonable person do
  • components of normative ethics
  • virtue
  • deontology
  • consequentialism
• deontology

  • posits that decisions/actions be made based on an individuals' duties and rights
  • proponents include Kant, John Rawls, and John Locke
  • Kant believed in a Categorical Imperative
  • a morality based on humanity's rational capacity and certain inviolable moral laws
  • example:
  • you get a prescription for norvasc
  • you're out of the brand but have the generic
  • should you fill the Rx with the generic, not tell anyone and bill for the brand?
  • no... it's wrong... it's fraud... it's unethical
  • even though the generic works just as well
• consequentialism

  • belief that the morality of an act is based on the result or outcome of the act
  • at least 8 different types of consequentialism
  • such as: welfarism, egoism, situational ethics, intellectualism
• consequentialism issue

  • the CA assembly has considered in the past paying health care professionals on outcomes, results
  • can you control what a pt does after they leave the pharmacy?
  • some Rx manufacturers are starting to invoice price based on results... especially pricey drugs
• other types of normative ethics

  • relational ethics
  • founded by feminist theorists such as Carol Gilligan
  • morality arises from empathy, compassion
  • emphasizes relationships in achieving ethical goals
  • it sees issues as contextual and narrative versus formal and abstract
  • pragmatic ethics
  • moral correctness "evolves" over many lifetimes
• 7 fundamental ethical principles

  • respect for autonomy
  • beneficence
  • nonmaleficence
  • justice
  • proportionality
  • efficiency
  • health maximization
• terminology

  • non-maleficence: do no harm, even if asked
  • beneficence: heal and help according to ability, judgment
  • health maximization: health outcomes or broader constituency
  • not a micro-encounter
  • can come into conflict with non-maleficence and beneficence
  • efficiency: more health resource needs than resources; always
  • do the most good for the people
  • some moral issues are here
• terminology (cont.)

  • autonomy: fundamental reminder that every person has a high value
  • leads to tension between individual rights and a "greater" public health good
  • for example: limiting movement during a pandemic
  • justice: answers the question: what do we owe each other?
  • we all have equal moral value and a "different treatment" of some demands a high burden of proof
  • justice demands equal opportunity
  • proportionality: a normative thing; positive features and benefits must be balanced against negative features and benefits
  • casuistic: resolve an issue of conscience with ethical ideas
• so what?

  • led to an entire industry of "outside of the box" proponents
  • led to the belief that business management, creativity and problem-solving REQUIRED you to think outside the box
  • consultant who pronounced that "outside the box" thinking was critical became multi-millionaires
• so what? (cont.)

  • conclusion: if only 1 in 4 can solve a problem by thinking outside the box, when they're told how to do it, there's a serious flaw
  • thinking outside the box is not a reliable tool for solving pharmacy management problems
  • most pharmacy management issues can be resolved by thinking inside the box
  • solutions are contained in a small space surrounding the problem, focusing on using resources you already control
  • a management style, a problem solving philosophy and innovation kick start all in one
  • it never has been. it's just a tired, old and (almost) completely WRONG euphemism
• why should you care?

  • thinking inside the box is a differentiator
  • so, during an interview for a pharmacist/manager's role you REALLY want, you might find a moment to say:
  • "I think most problems w/in a pharmacy can be solved by focusing on resources already at hand"
• a bioethical management model - a problem solving tool

  • here's a model you can follow if you choose - ECHO
  • economical
  • clinical
  • humanistic
  • outcomes oriented
• guaranteed exam question

  • what is gross profit?
  • an amount of dollar or percent profit
  • how is it calculated?
  • sell price - (cost/sell price)
  • example: $1 (sell) - 0.50 (cost)/$1 (sell) = 50%
• another guaranteed exam question

  • how do you figure out net profit?
  • sell cost - cost - (total expenses/sell cost)
  • example
  • $1 - 0.50 - (0.25/$1) = 0.25 and 25%